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WORLD GASTROENTEROLOGY NEWS JULY 2014
Editorial | Expert Point of View | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events
FMT: Quality Control and
Feasibility
It would be ideal to standardize FMT.
If the purification of fecal micro-biota
can be technically controlled it
might be more available; otherwise
its application in the world would be
restricted by health policy if there is
no quality control.
The best solution for this prob-lem
is to allow the procedures to
be performed automatically with
machines, GenFMTer. The latest
news, from my team cooperating with
Dr. Youquan Zhao and Dr. Huiquan
Wang at Tianjin University Preci-sion
Instrument College in China, is
the successful development of a new
automatic system for purification of
fecal microbiota from fresh feces. This
will advance the standardized FMT
from a bio-safety cabinet to automatic
instruments. The operator only needs
to press the buttons related to the
designated processes and all proce-dures
can be done in less than a half
an hour. Since we do not know the
changing of fecal viable organism after
the feces is expulsed from the colon,
it may be the best way to transplant
those microbiota back to the gut as
soon as possible.
What Will We Do in the Future?
FMT has been used as a rescue ther-apy
for refractory IBD in our center,
treating patients from all over China.
These patients generally had compli-cated
IBD. However FMT should
not be regarded as a pure technology
when it is used for patients with se-vere
diseases. Additionally, it remains
unclear why some cases with IBD did
not response to FMT.
Our clinical pilot demonstrates
that FMT through the mid-gut may
be a safe, feasible and efficient rescue
therapeutic option for refractory IBD.
In the future, multi-center random-ized
clinical trials should be done.
Also, more studies are needed to focus
on mechanisms, indications, method-ology,
cost-effectiveness analysis and
long-term safety. As an effective, safe
and economic therapy, FMT may be
moved into the mainstream of IBD
treatment sometime in the future.
References
1. Zhang F, Luo W, Shi Y, Fan Z,
Ji G. Should we standardize the
1,700-year-old fecal microbiota
transplantation. Am J Gastroen-terol.
2012;107:1755; author reply
p.1755-1756.
2. Eiseman B, Silen W, Bascom GS,
Kauvar AJ. Fecal enema as an ad-junct
in the treatment of pseudo-membranous
enterocolitis. Surgery.
1958;44:854-859.
3. Hamilton MJ, Weingarden AR,
Sadowsky MJ, Khoruts A. Stan-dardized
frozen preparation for
transplantation of fecal microbiota
for recurrent Clostridium diffi-cile
infection. Am J Gastroenterol.
2012;107:761-767.
4. Surawicz CM, Brandt LJ, Binion
DG, Ananthakrishnan AN, Curry
SR, Gilligan PH, McFarland LV,
Mellow M, Zuckerbraun BS.
Guidelines for diagnosis, treatment,
and prevention of Clostridium dif-ficile
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5. Damman CJ, Miller SI, Surawicz
CM, Zisman TL. The microbiome
and inflammatory bowel disease:
is there a therapeutic role for fecal
microbiota transplantation. Am J
Gastroenterol. 2012;107:1452-1459.
6. Smits LP, Bouter KE, de Vos WM,
Borody TJ, Nieuwdorp M. Thera-peutic
potential of fecal microbiota
transplantation. Gastroenterology.
2013;145:946-953.
7. Zhang FM, Wang HG, Wang M,
Cui BT, Fan ZN, Ji GZ. Fecal mi-crobiota
transplantation for severe
enterocolonic fistulizing Crohn’s
disease. World J Gastroenterol.
2013;19:7213-7216.
8. Kao D, Hotte N, Gillevet P, Mad-sen
K. Fecal Microbiota Trans-plantation
Inducing Remission in
Crohn’s Colitis and the Associated
Changes in Fecal Microbial Profile.
J Clin Gastroenterol. 2014. Epub
ahead of print.
9. Sha S, Liang J, Chen M, Xu B,
Liang C, Wei N, Wu K. Systematic
review: faecal microbiota transplan-tation
therapy for digestive and
nondigestive disorders in adults and
children. Aliment Pharmacol Ther.
2014;39:1003-1032.
An automatic system called GenFMTer was
used to isolate fecal microbiota from stool.